Bexar breaks law on mentally ill inmates

A Bexar County Jail prisoner stares at a corner while wearing a safety smock, which is used to keep mentally inmates from hurting themselves. He's in the lockup's Mental Health Unit, an austere, 18-cell wing where a psychiatrist visits once a day.

A Bexar County Jail prisoner stares at a corner while wearing a safety smock, which is used to keep mentally inmates from hurting themselves. He's in the lockup's Mental Health Unit, an austere, 18-cell wing where a psychiatrist visits once a day.

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Editor's note: This story originally appeared Sunday, Aug. 1, exclusively in the print edition of the San Antonio Express-News.

Bexar County is breaking a state law requiring the swift examination of every mentally ill prisoner in jail, leaving an untold number of inmates languishing without proper psychiatric care.

Local courts are supposed to order psychiatric exams and use the results to route many of the mentally ill offenders toward treatment and away from the jail, where only one part-time and two full-time psychiatrists are employed to treat about 900 inmates a day suffering from some form of mental illness.

The jail is screening inmates when they are booked and providing a daily list of the mentally ill to magistrates.

But the courts at that point drop the ball, saying they are overwhelmed and lack the resources to order the examinations or distribute reports to attorneys. And mental health providers inside the jail say they lack the staff to adequately examine every prisoner who might be mentally ill.

As a result, the jail continues to warehouse mentally ill offenders accused of minor crimes who would be better served in psychiatric hospitals. The courts’ failure to follow the law contributes to crowding at the jail, where an estimated 21 percent of the 4,500 prisoners have a mental illness.

Rep. Pete Gallego, D-Alpine, who sponsored a bill last year to clarify how officials must share information about inmates’ mental health, said the law’s aim is to ensure resources are directed more efficiently.

“The goal is to do it up front,” Gallego said. “The way the system was working was, you weren’t catching (the mentally ill) until the tail end, and by then the person had been sitting in jail and needing health care for a period of time.”

Amended in the last legislative session, the law now requires jail officials to notify “a magistrate” within 72 hours of learning that a prisoner is mentally ill.

The magistrate then must order an examination of the inmate, and a report of this examination — including a recommended course of treatment — must be submitted to the magistrate within 30 days of the order.

The magistrate then must send a copy of the report to the prosecutor and the defendant’s lawyer. The court can’t resume criminal proceedings against the inmate until after it receives the examination report, according to the law.

But local magistrates aren’t following through after they receive the jail lists.

“Without this information, how are you going to serve justice?” she asked.

Bexar County Criminal Magistrate Judge Andrew Carruthers said facilitating the process is not his job.

“I have a full-time responsibility working for 10 criminal district courts,” Carruthers said. “My schedule will not accommodate that.”

He added that the law “says ‘a magistrate.’ It does not say the criminal magistrate of Bexar County.”

Carruthers made that much clear when he wrote jail officials a bemused memo in March.

“Over the past several weeks, someone in jail administration has been e-mailing me a list of persons suspected of having a mental illness,” he wrote, adding that his “duties and resources do not encompass compliance” with the law, Article 16.22 of the Texas Criminal Code.

“That’s part of the problem,” she said. “We don’t know who they mean. And the poor jail doesn’t know who they mean.”

Fischer said judges at the county’s central magistrates’ office, where three work full time and nine work part time, are “not doing mental health evaluations. That’s not their job.”

She added, “Most (Texas) counties are like us. They don’t have the resources and they have not implemented this to the letter of the law, like it should be.”

In a May letter, District Judge Mary Roman told county commissioners that Bexar lacks “additional medical personnel, mental health magistrates and administrative staff” to follow the law but is in “substantial compliance with the intent of Article 16.22.”

“We’re doing everything we can at this point,” Roman said in a recent interview. “We would be glad to do even more, but the resources have to be there, and we’re not in charge of the resources.”

Roman said she believes the statute is more suited for smaller, rural counties, an assertion echoed by other local officials, including Bexar County Sheriff Amadeo Ortiz and District Attorney Susan Reed.

Gallego refuted that.

“I would argue that Austin, San Antonio, Houston, Dallas, Fort Worth, El Paso, just statistically, they’re going to have more people with mental health issues in their jails than the rural counties are,” the lawmaker said.

He called so-called “substantial compliance” with the law insufficient.

“The analogy that I’ve used is basketball,” Gallego said. “The ball either goes through the hoop or it doesn’t.”

225 days

One severely mentally ill inmate in jail today first saw the inside of a cell nearly two decades ago.

Alejandro started hearing voices when he was 19.

The television, he believed, was broadcasting ominous messages to him, and so was the family’s dachshund, which he tried to give away to a stranger.

His moods began souring.

His parents, Leonides and Rafaela, urged him to see a doctor, but he refused. In 1991, the deadlock broke: Alejandro, then 23, beat his father, punching him several times in the head, a police report states.

Alejandro, who asked that his last name not be used, was jailed for 10 days until a judge dismissed the case and ordered him sent to San Antonio State Hospital.

For years, his paranoid schizophrenia was reasonably controlled with medication. Then his pills stopped working, and he began self-medicating with alcohol and marijuana.

Police arrested him for possession of marijuana in 1997, the first in a string of nearly a dozen misdemeanors that would repeatedly land him in jail over the next 13 years.

Again and again, Alejandro would earn release on conditions of probation that he invariably would violate, resulting in more time in jail.

Over the years, Alejandro has been incarcerated seven times, a total of 225 days, in Bexar County Jail, where he remains today after violating conditions of his probation on charges of driving while intoxicated and again assaulting his father, this time stepping on his father’s foot.

“There was no bruising, really,” said Edward Piker, Alejandro’s court-appointed attorney in that case. “It was very minor. But he was arrested for assaulting the elderly anyway.”

It is unclear whether the extent of Alejandro’s mental illness was considered during his sentencing in March, when Judge Monica Guerrero found him guilty of the assault and imposed more conditions of probation — community service, stress education and others.

Alejandro failed to complete the terms and he was subsequently arrested for reckless driving, resulting in his current incarceration.

Guerrero wouldn’t comment specifically on the case but spoke generally of court procedures.

“I depend on attorneys to find out about anyone’s mental illness,” she said. “If we find out there’s a hardship or an illness, it could preclude community service.”

Piker conceded he did not subpoena Alejandro’s psychiatric records.

“I don’t remember if I specifically said (he suffers from paranoid schizophrenia) or not,” Piker said.

Associate Probate Judge Oscar Kazen, who presides over hearings to commit those in mental health crises, said Article 16.22 was amended to avoid such uncertainties.

“Right now, (the system) is ad hoc, and it relies on a lot of good luck and good will,” Kazen said. “If you don’t have the luck, somebody can slip by.”

Weeks before his most recent arrest, Alejandro sat at the kitchen table of his parents’ townhouse. He’d recently emerged from an 81-day stint in the jail and had just risen from a midday nap.

Asked about his time in jail, Alejandro paused a full minute before answering.

“The criminals are hard,” he said quietly, “but the guards are harder.”

Padded cells

Dr. Sally Taylor arrived at the county jail in 2008 as director of its psychiatric services.

She since has pushed strategies to divert mentally ill inmates, measures that local officials cite in support of the claim that Bexar County is in “substantial compliance” with Article 16.22.

Here’s one: When an inmate’s mental illness is so severe that he or she’s a danger to self or others, Taylor’s staff sometimes requests a review by the district attorney’s office for possible dismissal of charges. If dismissal is possible and a bed is available, the inmate is released directly from jail to a psychiatric facility.

And every 72 hours, Taylor’s staff sends a list of inmates suspected of “severe mental illness” at the time of booking to the county’s four mental health criminal public defenders and the coordinator of County Court-at Law No. 12, which runs a mental health docket once a week.

The process to determine if an offender is mentally ill begins in the jail’s booking area, where all inmates are asked a series of questions on a one-page sheet, including, “Do you hear any noises or voices that other people don’t seem to hear?”

If answers raise suspicions, the inmate is moved to a different area, where a social worker conducts a more in-depth assessment. Composed of three desks separated by glass partitions, it’s a busy area with little privacy.

If there’s an open cell, mentally ill inmates in crisis go to the Mental Health Unit, an austere, 18-cell wing in which they’re visited once a day by a psychiatrist.

In the unit’s two padded cells, the only accommodation is a blue mattress on a bench and a floor grate as a toilet. The walls, still hard but softer than cement, bear the fingernail-etched scrawls of former inhabitants, who are monitored by cameras 24 hours a day.

On a recent day, a man banged his head against his cell door and yelled threats. Another man stood at his window and carried on an animated conversation with himself.

Last year, Taylor’s staff conducted about 8,200 assessments and provided psychiatric treatment for about 3,000 inmates. That same year, five inmates committed suicide, more than three times the national average.

With fewer than three psychiatrists on staff, Taylor conceded that “we can always use more” resources for treatment.

“We try to triage them,” she said, “so somebody with a less severe illness is going to wait longer. That’s just the nature of limited resources anywhere.”

Leaving jail

Local officials cite the assessments conducted by Taylor’s staff as evidence that the county is complying with “the spirit” of Article 16.22.

But Taylor said the mental health evaluations required by the law “would have to include things that we wouldn’t normally include in an evaluation when we’re just treating somebody.”

Carruthers, the magistrate, confirmed: “It’s a different type of assessment.”

He added, “It might make the court aware of the person’s mental illness where they otherwise would not be aware of that.”

There is apparently little political will to comply with the law.

Bexar County Judge Nelson Wolff said the bill “sounded to me like it’s more of a bureaucratic papering job than it is actually treating somebody.”

Advocates and policymakers, however, say ensuring that mental health evaluations are shared would result in both more streamlined care and savings.

“Once you know exactly what (a mentally ill person) needs,” Yañez-Correa said, “communities can make smarter and more strategic decisions on how to care for them, and ultimately that is going to result in savings.”

After years of repeated incarcerations, Alejandro finally is going somewhere other than the county jail to serve his sentence.

Last week, his probation officer successfully sought an order for his eventual transfer to the county’s Mentally Ill Offenders Facility, where he is to receive drug counseling, medication and other services for 120 days.

Even as their jailed son continues to wait for an opening there, Alejandro’s parents were glad he is cleared to leave.

“We want people to understand that those with mental illness don’t need jails,” his father said. “They need hospitals.”